Palpitations

Understanding palpitations

Palpitations are when you become aware of your heartbeat — it may feel fast, slow, pounding, fluttering, or as though it skips a beat. Almost everyone experiences them at some point, and they are often harmless, especially when linked to a clear trigger such as stress, caffeine or exercise. Because they can occasionally indicate a heart rhythm problem, it is worth knowing when to get checked.

What palpitations feel like

People describe palpitations in different ways. Some feel a pounding or thumping in the chest, while others notice a racing heartbeat, a fluttering or “flip-flopping” sensation, or skipped and extra beats. Some people become aware of their heartbeat in the throat or neck.

Palpitations may last seconds or minutes. Many people notice them most when lying in bed at night, when everything is quiet.

Common harmless causes of palpitations

Lifestyle triggers are among the most common causes. Caffeine — found in coffee, tea, energy drinks and chocolate — as well as alcohol, nicotine, dehydration and lack of sleep can all bring on palpitations. Strenuous exercise raises your heart rate too, which is a normal response to activity.

Emotional causes are also common. Anxiety and stress release adrenaline, which increases your heart rate, and panic attacks can cause a sudden racing heart with breathlessness and fear.

Physical causes include hormonal changes during pregnancy, the menopause and thyroid problems, as well as fever and general illness. Anaemia reduces the blood’s oxygen-carrying capacity, so the heart has to work harder.

Some medicines can trigger palpitations as well. These include decongestants found in cold remedies, asthma inhalers such as salbutamol, and some antidepressants.

When palpitations may need treatment

Some heart rhythm problems cause palpitations and need medical management. Atrial fibrillation (AF) is an irregular, often rapid heartbeat that becomes more common over the age of 65. It increases the risk of stroke and usually needs treatment to control the heart rate and reduce the risk of clots.

Supraventricular tachycardia (SVT) causes sudden episodes of a very fast but regular heartbeat, which can start and stop abruptly. It sometimes needs specialist treatment. Other arrhythmias can also cause palpitations, and a GP or cardiologist identifies these with ECG monitoring.

Self-care for palpitations

If palpitations are occasional and you feel well otherwise, simple changes can help. Reducing caffeine and alcohol, managing stress with breathing exercises and regular sleep, and staying well hydrated all make palpitations less likely. It also helps to note when palpitations occur — including any triggers, how long they last and any other symptoms — because this information is useful for your GP.

The vagal manoeuvre (bearing down as if on the toilet, or splashing cold water on the face) can sometimes slow a fast heartbeat, but only try this if you have been shown how and do not have serious symptoms.

When to see a GP about palpitations

Book a GP appointment if:

• your palpitations are frequent or becoming more frequent
• episodes last more than a few minutes
• you feel dizzy, faint or breathless during palpitations
• you have a known heart condition
• your pulse feels consistently irregular

A GP can check your pulse and arrange an ECG, blood tests to check for thyroid problems and anaemia, and a heart monitor if one is needed.

When to seek emergency help for palpitations

Call 999 if:

• palpitations come with chest pain or pressure
• you become severely breathless
• you faint or nearly faint
• palpitations last more than a few minutes and you feel very unwell

These symptoms could indicate a heart attack or a dangerous arrhythmia.

Palpitations and anxiety

Anxiety and palpitations often feed each other — a racing heart causes worry, which releases more adrenaline. Treating anxiety with talking therapy, lifestyle changes and sometimes medication often reduces palpitations. A GP can assess whether anxiety, a heart rhythm issue, or both are contributing.

Living with occasional palpitations

If investigations are normal and your triggers have been identified, palpitations can usually be managed by avoiding those triggers and staying generally healthy — with regular exercise, a balanced diet, not smoking and moderating caffeine. Knowing that your heart is structurally normal provides reassurance for many people.

Common questions about palpitations

What do palpitations feel like?

Palpitations feel like an awareness of your own heartbeat — it may pound, race, flutter or seem to skip beats. You may feel them in your chest, throat or neck. They can last from a few seconds to several minutes, or occasionally longer.

Are palpitations dangerous?

Palpitations are usually not dangerous, and many healthy people notice them during stress, after caffeine or during exercise. Persistent palpitations, or palpitations with other symptoms, should still be checked, because some heart rhythm problems need treatment.

What triggers palpitations?

Common triggers of palpitations include stress and anxiety, caffeine from coffee and energy drinks, alcohol, nicotine, dehydration, lack of sleep and vigorous exercise. Hormonal changes, including pregnancy and menopause, and some medicines, such as decongestants and asthma inhalers, can also set them off.

What is atrial fibrillation?

Atrial fibrillation (AF) is an irregular, often fast heartbeat that becomes more common over the age of 65. It increases the risk of stroke and usually needs treatment with anticoagulation and rate control. Palpitations with an irregular pulse should always be assessed.

What tests will a GP do for palpitations?

A GP will usually arrange an ECG (a heart tracing) and blood tests, including checks of your thyroid function and for anaemia. Some people also wear a heart monitor for 24 hours or more to capture intermittent episodes.

Sources

• NHS — Heart palpitations